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Flashcards in MIX 3 QBANK Deck (131):
1

indications for melanoma sentinel lymph node biopsy

thickness greater than 1 mm

2

treatment of thymoma

all should be approached with aggressive surgical management regardless of symptoms

Including invasive thymomas with radical resection

Postoperative radiation can improve local recurrence if pericapsular invasion

3

perioperative management of myasthenia gravis patient for thymoma

stop Anticholinesterase inhibitor 72 hours before surgery - decrease his pulmonary secretions

4

Hodgkin's lymphoma staging and associated cells

Reed-Sternberg

Stage I-single lymph node
Stage II-2 or more sites on the same side of diaphragm
Stage III-both sides the diaphragm, spleen is counted as involved lymph node tissue
Stage IV-disseminated and involved lymphatic organs

Constitutional symptoms designate B:
fever, weight loss, night sweats, pruritus

5

how are triglycerides processed

short and medium chain fatty acids

Tubes or by intestinal epithelium directly

6

how are longchain fatty foods processed

requires lipase
Transported in mixed micelles to enterocytes - then recent incised into triglycerides in the form of chylomicrons and the created in the intestinal lymph chyle

7

renal cell carcinoma risk factor, presentation, lap markers, site of metastases

major risk of smoking

Associated with paraneoplastic syndrome including:
Erythrocytosis
parathyroid like hormone: PTHrp
ACTH
Renton

LUNG most common site of metastases
Isolated metastases may be resected at time of operation

8

Treatment for renal cell carcinoma

radical nephrectomy

ONLY partial nephrectomy patient to require dialysis as a result of removing kidney

9

Brown-Séquard syndrome
presentation symptoms
Mechanism of injury
prognosis

injury to half the spinal cord

Ipsilateral loss of motor ( careful, this is opposite from brain)

Contralateral lots of pain and temperature

cause contralateral symptoms below level of injury:
Spinal thalamic
Posterior column

mechanisms of injury:
Disc herniation
Vasculitis and radiation exposure
Penetrating trauma


Prognosis: Variable

10

blood supply of cervical esophagus

inferior thyroid artery (branch of thyrocervical trunk from subclavian artery)

11

laboratory values associated with hemophilia

elevated APTT
normal PT and bleeding time

12

laboratory values associated with von Willebrand's

increased bleeding time from dysfunctional platelets

13

laboratory values associated with vitamin K deficiency

factors 2, 7, 9, 10 protein C and S.

increased PT AND aPTT

14

trauma patient with hemophilia A which should be given

if no factor concentrate preparations care of

CRYOPRECIPITATE ( more concentrated in FFP)

15

fuel source for colon

Short chain fatty acids
butyrate
propionate
acetate

Large bowel is short

16

fule source for small bowel

glutamine

17

diagnosing Zollinger-Ellison syndrome

gastrinoma
fasting serum gastrin will greater than 100
AND
and a basal acid output greater than 15
consistent with dx

Secretin stimulation test increased gastrin greater than 200 (110-120) confirms

Imaging:
Somatostatin scintigraphy greater sensitivity than all conventional studies combined

EUS high-sensitivity for detection of pancreatic gastrinoma

not good for duodenal gastrinom


If cannot find gastrinoma:
-hepatic vein sampling with calcium stimulation

18

left congenital cyanotic heart defect

tetralogy of flow
Transposition of great vessels
Pulmonary atresia with intact VSD
Pulmonary atresia with VSD
Valvular pulmonic stenosis

19

management of wrist drop after mid humerus shaft fracture

presence of radial nerve palsy does not indicate surgical exploration in all cases

possible indications include:
Open fracture
Stab injury

20

most common cause mortality of cardiac transplant after one year

atherosclerosis
Causes include:
Natural disease process
Diabetes
Hyperlipidemia
Smoking
Chronic immunosuppression
Opportunity to infection

21

first muscles to be paralyzed with neuromuscular blockade

facial muscles

22

first muscles to recover after neuromuscular blockade and

diaphragm

23

last muscles to be paralyzed after neuromuscular blockade

diaphragm

24

components innate immunity

complement system
Natural alar cells
Phaco sites
Epithelial barriers

25

physiologic response to tumor necrosis factor What is the source

cachexia

source:
Macrophages, monocytes, T cells

26

physiologic response to IL1

fever related to hypo-thalamus

27

physiologic response to IL-2

promotes T-cell perforation and immunoglobulin production

28

physiologic response to IL-4

T-cell differentiation B cell activation

29

physiologic response to GM-CSF

admits granulocyte and monocyte production from bone marrow stem cells

30

urine output goals myoglobinuria

2 cc per kilogram per hour

31

adverse event

injury the results medical management and result in measurable disability

this includes preventable and preventable - given the current state of knowledge

32

near miss

could have resulted in injury/accident

it was prevented by chance or intervention

33

latent error

condition of the system is removed from the adverse event

Insidious and may not become evident and telemetry series of events have cascaded into perfect storm

poor design, incorrect installation, faulty maintenance, or inadequate staffing.

34

Side effect and treatment of isoflurane blue dye

anaphylaxis

subcutaneous epinephrine

35

mechanism of magnesium sulfate for premature labor

competitive inhibition of calcium influx

tocolytic

also used a seizure prophylaxis and patient's with preeclampsia

36

fibrolamellar hepatocellular carcinoma findings on imaging, labs, prognosis

more aggressive

Central fibrotic component-well-circumscribed
careful, focal nodular hyperplasia also has central scar

Neurotensin positive
AFP negative

37

and what type of shock is venous oxygen saturation increased

septic shock

38

where are pancreatic damage and activated

duodenum

39

enzymes are secreted in active form from pancreas

Amylase
Lipase
ribonuclease
deoxyribonuclease

40

A stone located in the common bile duct after cholecystectomy designated as recurrent at what time.

2 years after cholecystectomy

41

Maxillary torus

a symptomatic lesion of the hard palate

Benign osteoblastic tumor

Treatment only if symptomatic

42

Glioma ENT tumor

just lateral to nasal root-reddish firm noncompressible lobular lesions with cutaneous telangiectasia

43

Submucosa cleft palate

triad:
Bifid uvula
Notch at the junction of the hard palate and soft palate
zona pellucida - thin layer of mucosa in the midline the soft palate

44

workup pyloric stenosis

diagnosis can sometimes definitively be made with physical exam alone

Ultrasound:
Thickness 3-4 mm
Length 15-18 mm

45

pyloric stenosis presentation

male female-4:1

First born male

Hypochloremic hypokalemic metabolic alkalosis

46

Pyloric stenosis treatment

after resuscitation
potassium is not replaced until intravascular volume had been restored with normal urine output


Microscopic pyloromyotomy

47

Most important prognosis factor for 32-year-old female with well-differentiated papillary carcinoma

age!
Male under the age of 40 females under the age of 50


presence of metastases less important!

48

With the thyroid cancer prognostic is

AMES

age
Metastases
Extent of involvement
signs of tumor

49

spigelian hernia

BELOW arcuate line

Between semilunar line in the lateral edge of rectus

Covered via external oblique aponeurosis-difficult to palpate-CT scan

Surgery: Transverse abdominal incision over defect

All require operation

50

innervation of external anal sphincter

voluntary control

inferior rectal branch of the internal pudendal nerve
And
Peroneal branch of fourth sacral nerve

51

Innervation of the internal anal sphincter

Involuntary

Autonomic nervous system

52

half life of nutritional markers

albumin 21 days
Transferrin 8 days
prealbumin 1-2 days

53

treatment of patent ductus arteriosus

term infant 90-95% closed by 4 days

Preterm infant 80-90% closed by 30-37 weeks gestational age

Term infant Cox inhibitors ineffective

Premature infant Cox inhibitors effective

Asymptomatic PDA surgery between age 1-2:
VATS or transcatheter

symptomatic infant prompt closure

54

lab marker associated with active hepatitis B infection

HBsAg
hepatitis B surface antigen

+1-10 weeks after infection

disappears in for-6 months but present impairment 5 chronic infection

HBcAg
hepatitis B core antigen
intracellular antigen not in C-arm

Detectable orally after infection and persist after recovery and in chronic infections

55

laboratory markers associated with hepatitis B vaccination

Anti-HBs
anti-hepatitis B antibody

( but also appeared during window. After antigen disappears marked to recovery after hepatitis B infection)

56

most accurate diagnosis of hepatitis B infection

quantification of hepatitis B DNA in the serum

57

management of perforated appendicitis

percutaneous drainage and antibiotics if abscess or fluid collection demonstrated

this is not the treatment if there are peritoneal signs

58

antibiotic use for appendectomy of

single perioperative dose most commonly

59

when with broad-spectrum IV antibiotics and interval appendectomy in 6-12 weeks be reasonable

phlegmon present-this is not drainable collection and surgical intervention can be difficult acutely

some advocate early appendectomy in this population though

60

Clark's levels

level I epidermis
Level II papillary dermis
Level III junction between papillary and reticular dermis
Level IV reticular dermis
Level V subcutaneous fat

61

most common cause of renovascular hypertension

atherosclerosis

62

Pathophysiology of hypertension with renal artery stenosis

decreased pressure in affarent barroreceptors
stimulate juxtaglomerular apparatus
activated ring and angiotensin axis

63

pores of Kohn in alveoli

communication between alveoli

64

at what age to alveolar production began

some months gestation and continued until 10 years

65

lab findings associated with tree renal azotemia rather than an intrinsic cause of renal failure

urine sodium of less than 20 - this is consistent with the body trying to reabsorb sodium for water to follow.

FENa less than 1%

66

lifetime risk of postsplenectomy sepsis without immunos

1-5%

67

ovarian cancer staging

stage I-one or both ovaries only can be treated with resection alone

Stage II-extended involvement of tumor but limited to pelvis

Stage III-tumor involvement of the abdomen

Stage IV-distant metastases

68

mechanism of action of Finasteride

competitive inhibition of:
5a-Reductase

decreased serum and intra-prostate levels of dihydrotestosterone

helps relieve bladder obstruction

69

intraoperative parathormone assay

half-life 3-5 minutes

Within 10 minutes the excision:
50% drop of highest pre-excisional value indicates complete resection of hyperfunctional gland

70

Management if PTH does not drop to 50% and 10 minutes

Confirmed there is remaining hyperfunctioning tissue

Does not imply that gland removed was normal

71

treatment of undifferentiated spindle cell malignant fibrous histiocytoma of the bone

preop chemotherapy

Surgical resection

Most common site proximal tibia distal femur

72

treatment of infected pseudocyst

aspirated not draining by CT guidance or ultrasound

Gram stain and culture

If infection present, external drainage using surgical or percutaneous technique

73

cells responsible for contractile forces of the wound healing

myoepithelial cells

found in the basal layer of epithelium

74

most common cause of primary hyperparathyroidism

adenoma

hyperplasia is less common - though seen in MEN 1 and 2a

75

mechanism of dobutamine

only Beta adrenergic stimulation
using cardiogenic shock

low dose- beta one-contractility

high-dose-beta-2-vasodilation

76

Marjolin's ulcer

scar/burn squamous cell carcinoma

Majors have scars and burns

77

treatment of Marjolin's ulcer

surgical excision with 3-4 mm normal-appearing skin

Intraoperative frozen section

Surgery preferred and scarred or traumatized areas

Radiation is useful and high risk for recurrence after extensive surgical excision

Mohs procedure reserved for lesions with indistinct margins in areas where the important preserve skin

78

with cell releases tumor necrosis factor alpha

macrophages

principal mediator for gram-negative response
TNF also responsible for cachexia

79

femoral canal boundaries

superior-iliopubic tract

Inferior-Cooper's ligament

Medial-lacunar ligament

Lateral-femoral vein (careful, overall location of femoral veins medial compared artery)

80

first-order kinetic

elimination is directly proportional to blood concentration

most drugs follow this

81

zero order kinetic

elimination is independent of the concentration

seen with alcohol

82

SIADH physiologic findings

reabsorbing too much water
despite this, patient's remain overall normal volemic

sodium retention in the kidney needs to concentrated urine

83

what causes the periumbilical pain and acute appendicitis versus right lower quadrant pain pathophysiology of innervation

appendiceal luminal distention which activated visceral pain fibers causing the initial periumbilical pain

Peritoneal signs from inflammation her carried via somatic nerve fibers in the right lower quadrant

84

management of gallbladder adenoma

symptomatic adenomas are resected laparoscopically unless suspicious for malignancy

Asymptomatic adenomas not concerning for malignancy are followed q.6 months with ultrasound

Enlarging adenomas are resected

85

Suspicious for malignancy adenomas

greater than 1 cm
Greater than 3 in number
Sessile
Mucosal invasion on ultrasound

86

nerve involved with numbness in the foot drop - findings and common etiologies

common peroneal

Motor deficit often worse and sensory

supracondylar fracture
Proximal tibial fracture
Knee dislocation

87

gold standard test her insulinoma

72 hour fasting:
Him serum glucose and Ambien insulin concentration every 6 hours as collected and symptoms develop

Diagnoses is made if patient develops neural glycopenic symptoms and C-arm glucose is low her than 45 with CM insulin level higher than 5

C-peptide and Prolenes and confirm factitious causes

88

mechanism of urokinase

all thrombolyzes agents packed by converting Prolenes on plasminogen to plasma and

TPA recumbent

Converts plasminogen to plasmin

89

when is systemic thrombolysis used

acute myocardial infarction
Acute ischemic stroke
Massive pulmonary embolism

90

mechanism heparin

ACTIVATES antithrombin 3

This accelerated rate the anti-thrombin inhibitor enzymes of coagulation:
Thrombin
Factor X a

91

Organ of Zuckerkandl

most common site of pheochromocytomas

Anterior and lateral to distal abdominal aorta between takeoff of the inferior mesenteric artery and aortic bifurcation

92

treatment of 1 cm anal margin squamous cell carcinoma

excision

IS not Niagara protocol

93

treatment of recurrent squamous cell carcinoma of anal margin

possibly reexcision or APR

94

indications for nigro protocol

intra-anal lesion
Invasion of sphincter
possibly greater than 3 cm

5 fluorouracil

Mitomycin-C

3000 cGy

95

innervation of upper epiglottis

glossopharyngeal nerve

sensory pathway of gag reflex

96

innervation of lower epiglottis

recurrent laryngeal nerve

97

muscles innervated by recurrent laryngeal nerve

lower epiglottis
All the muscles of the larynx except for the cricothyroid

98

type of innervation by superior recurrent laryngeal nerve

sensory! helps for feedback of pitch

99

Mycobacterium avium

aerobic non spore forming motile past bacilli

pulmonary disease with intact immune system

Disseminated disease with immunocompromise

100

Confirmation of disseminated Mycobacterium avium

culture positive:
Blood, bone marrow, liver, spleen

positive stool culture may just indicate carrier status

101

most common clinical presentation of Meckel's diverticulum in children

bleeding

102

name of hernia with Meckel's diverticulum and it

Littre's hernia

103

first step of workup for Stewart-Treves syndrome

incisional biopsy

104

treatment of Stewart-Treves syndrome

wide local excision with or without chemotherapy or radiation

105

what does the spinal accessory nerve innervated

sternocleidomastoid and trapezius

motor nerve only

106

where he fibers originate from first spinal accessory nerve

cranial root and medulla

cranial fibers exit jugular foramen

found in posterior triangle

107

normally distributed data

is perinephric

conforms to bell-shaped curved

108

Treatment of entamoeba the histolytica liver abscess

metronidazole

109

CT findings that differentiate entamoeba the histolytica liver abscess from pyogenic liver abscess

non-ring enhancing

110

mechanism of Mycophenolate Mofetil

CellCept

Purine synthesis inhibition

inhibits inosine monophosphate dehydrogenase and blocks the proliferation of lymphocytes.


111

major mechanism of corticosteroids and immunosuppression

inhibits cytokine gene transcription in macrophages

and inhibit cytokine secretion:
IL1
IL 6
TNF

suppress T cells

112

mechanism of cyclosporine

inhibit cytokine symphysis
IL-2 3 4
INF gamma

113

guidelines for intercranial pressure monitoring

post resuscitation GCS equal to or less than 8
and abnormal CT scan

Even with normal CT if:
H. greater than 40
History of hypotension
Abnormal motor posturing

consider inpatient with GCS of 12 or less who cannot be closely monitored clinically or CT scan demonstrates intracranial hypertension

114

Blood supply of the lungs

dual blood supply

Deoxygenated blood from pulmonary artery

oxygenated blood from bronchial arteries

2 left-sided bronchial arteries and one right sided bronchial artery (careful, even though 3 lobes on the right)

origin of bronchial arteries:
Thoracic aorta or arch but can join with intercostals

Some of venous return is via pulmonary veins

115

pulmonary sequestration

left more common for both

intralobar:
Within the lung parenchyma
mediastinum
posterior segments of the lower lobes
SYSTEMIC vessels from infradiaphragmatic aorta
found in inferior pulmonary ligament
Venous drainage through inferior pulmonary vein but can be systemic veins
workup: CT MRI more common than angio
treatment: Segmentectomy or lobectomy

Extralobar:
Surrounded by separate pleural covering
more common extrapulmonary anomalies

116

normal resting lower esophageal sphincter pressure

10–20

117

Lower esophageal sphincter pressure during swallow

zero

118

Normal resting upper esophageal sphincter pressure

50-70

119

most common cause a splenic vein thrombosis

chronic pancreatitis

pseudocyst can also cause this

120

neck step in management with palpable neck mass calcium of 15 elevated PTH

NO FNA

En bloc total parathyroidectomy with ipsilateral thyroidectomy

121

management of delayed presentation of femoral artery trauma

in almost always be managed with direct repair.

122

management of popliteal artery trauma

Popliteal artery injury usually require interposition grafting

123

Management of isolated tibial vessel injury

No treatment needed as long as one out of 3 vessels patent

124

Neonatal and prenatal testicle torsion

extravaginal-testicle and both layers of the tunica vaginalis rotate

May not produce symptoms the testicle was atrophied and salvage is rare

125

testicular torsion and young adults and children

interventional-testicle and inner layer of tunica vaginalis rotate

Clinical diagnosis-no ultrasound needed

126

Review most somatostatin neuromas originate

periampullary and ampullary region most common site
proximal pancreas
or pancreaticoduodenal groove

127

Cloot triangle

common HEPATIC duct
Cystic duct
Free edge of the liver

Contains colon
Cystic artery

128

was common site for VIP Oma

body and tail

129

Most common site for glucagonoma

body and tail

130

Treatment for squamous cell carcinoma of the volva

less than 1 mm depth wide local excision

Greater than 1 mm depth:
Radical vulvectomy extends to endopelvic fascia
2 cm margin
Bilateral inguinal node dissection

If the lesion is ipsilateral ipsilateral inguinal node dissection

Positive nodes or extension into vagina or anus requires adjuvant chemotherapy and radiation therapy

131

with at what level does the innominate artery across the trachea

fifth tracheal ring